Uric acid–lowering treatment in patients with gout and comorbid conditions

Robert McLean, MD, is a rheumatologist and associate clinical professor of medicine at Yale School of Medicine, USA.

Which kidney comorbidities are an indication to use a uric acid–lowering treatment in gout?

The current guidelines would suggest, or state that people who have chronic kidney disease (CKD) stage 3 or greater are not clearing uric acid nearly as efficiently as someone who doesn’t have that. If they have gout and they are even mildly hypouricemic, which they likely are, they probably should be treated with a uric acid–lowering therapy earlier rather than later, because the likelihood that any other interventions—the likelihood that changing their diet, the likelihood that changing their diuretic medication—are going to have a significant impact on lowering uric acid is probably pretty remote. So, one of the indications in treating people after even like a first episode of gout is if in fact they have CKD, because their likelihood of having recurrent gout is extremely high.